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Positive Correlation With Response to Photopheresis

Lars E. French, MD; Stuart R. Lessin, MD; Kathakali Addya, PhD; Barbara Denardo, RN; David J. Margolis, MD, MSCE; Debra G. B. Leonard, MD, PhD; Alain H. Rook, MD

Arch Dermatol. 2001;137:1309-1313.

Objectives  To search for circulating clonal T-cell populations in patients with systemic sclerosis (SSc), and to determine whether T-cell clonality in the blood predicts therapeutic response to photopheresis.

Design  Analysis of clonal T-cell receptor gene rearrangements before photopheresis treatment and blinded clinical evaluation of cutaneous response to photopheresis in a case series.

Setting  University hospital setting.

Patients  Thirteen consecutive patients with SSc.

Interventions  Photopheresis in 11 patients.

Main Outcome Measures  Clonality of T cells in the blood before photopheresis and clinical response to photopheresis.

Results  Screening of blood samples from 13 SSc patients for clonal T-cell receptor gene rearrangements revealed a monoclonal T cell population in 6 (46%) of 13 SSc patients. Clinical response to photopheresis in 11 patients was evaluated in a blinded manner using skin severity scores. Clonality of T cells appeared to be associated with a higher chance of response to photopheresis therapy, as 4 (67%) of 6 patients in the clone-positive group vs 1 (20%) of 5 in the clone-negative group experienced a clinically significant response to treatment.

Conclusions  A high proportion of patients with SSc have detectable expanded clonal T-cell populations in the peripheral blood, and such patients appear more likely to respond to photopheresis.

From the Department of Dermatology (Drs French, Margolis, and Rook and Ms Denardo), and the Cancer Center Molecular Diagnostic Core, Department of Pathology and Laboratory of Medicine B (Drs Addya and Leonard), University of Pennsylvania, and Fox Chase Cancer Center (Dr Lessin), Philadelphia, Pa. Dr French is now with the Department of Dermatology, Geneva University Hospital, Geneva, Switzerland.

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